Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Serologic immunogenicity and safety of herpes zoster subunit vaccine in patients with rheumatoid arthritis receiving Janus kinase inhibitors

Källmark, Hanna LU orcid ; Bergström, Tomas ; Nagel, Johanna LU ; Gullstrand, Birgitta LU ; Einarsson, Jon T. LU orcid ; Bengtsson, Anders A. LU and Kapetanovic, Meliha C. LU (2024) In Rheumatology (United Kingdom) 63(7). p.2024-2033
Abstract

Objective: Patients with RA treated with Janus kinase inhibitors (JAKis) are at increased risk of herpes zoster (HZ). The objective of this study was to investigate the serological immunogenicity and safety of the HZ subunit (HZ/su) vaccine in RA patients treated with JAKi, for which little is known. Methods: RA patients treated with JAKi (n = 82) at the Department of Rheumatology, Skåne University Hospital, Lund and Malmö, Sweden, and healthy controls (n = 51) received two doses of the HZ/su vaccine (Shingrix). Vaccine-specific antibody responses were analysed using indirect ELISA. Post-vaccination antibody levels were compared between patients and controls using analysis of covariance. Potential predictors for vaccine response were... (More)

Objective: Patients with RA treated with Janus kinase inhibitors (JAKis) are at increased risk of herpes zoster (HZ). The objective of this study was to investigate the serological immunogenicity and safety of the HZ subunit (HZ/su) vaccine in RA patients treated with JAKi, for which little is known. Methods: RA patients treated with JAKi (n = 82) at the Department of Rheumatology, Skåne University Hospital, Lund and Malmö, Sweden, and healthy controls (n = 51) received two doses of the HZ/su vaccine (Shingrix). Vaccine-specific antibody responses were analysed using indirect ELISA. Post-vaccination antibody levels were compared between patients and controls using analysis of covariance. Potential predictors for vaccine response were investigated using a multivariable linear regression analysis. Self-reported adverse events (AEs) and changes in RA disease activity were analysed. Results: Following vaccination, vaccine-specific antibody levels increased significantly in both patients and controls (P < 0.0001). A total of 80.5% of patients and 98.0% of controls achieved a ≥4-fold increase in antibody levels. Post-vaccination antibody levels were lower in patients than controls [ratio 0.44 (95% CI 0.31, 0.63)] and lower in patients receiving JAKi + methotrexate than JAKi monotherapy [ratio 0.43 (95% CI 0.24, 0.79)]. AEs, mostly mild/moderate, were common. One patient developed HZ and six patients (6.5%) had increased RA disease activity following vaccination. Conclusion: The HZ/su vaccine was serologically immunogenic in most RA patients treated with JAKi. Moreover, the vaccine had an acceptable safety profile. These results support recommendations for use of the HZ/su vaccine in this vulnerable population.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
herpes zoster, Janus kinase inhibitors, rheumatoid arthritis, vaccination, vaccine immunogenicity
in
Rheumatology (United Kingdom)
volume
63
issue
7
pages
10 pages
publisher
Oxford University Press
external identifiers
  • scopus:85197632456
  • pmid:37851412
ISSN
1462-0324
DOI
10.1093/rheumatology/kead552
language
English
LU publication?
yes
id
46dfa75a-ac51-4f7d-aa1f-f38c7d7febae
date added to LUP
2024-10-03 15:15:03
date last changed
2025-05-02 14:31:10
@article{46dfa75a-ac51-4f7d-aa1f-f38c7d7febae,
  abstract     = {{<p>Objective: Patients with RA treated with Janus kinase inhibitors (JAKis) are at increased risk of herpes zoster (HZ). The objective of this study was to investigate the serological immunogenicity and safety of the HZ subunit (HZ/su) vaccine in RA patients treated with JAKi, for which little is known. Methods: RA patients treated with JAKi (n = 82) at the Department of Rheumatology, Skåne University Hospital, Lund and Malmö, Sweden, and healthy controls (n = 51) received two doses of the HZ/su vaccine (Shingrix). Vaccine-specific antibody responses were analysed using indirect ELISA. Post-vaccination antibody levels were compared between patients and controls using analysis of covariance. Potential predictors for vaccine response were investigated using a multivariable linear regression analysis. Self-reported adverse events (AEs) and changes in RA disease activity were analysed. Results: Following vaccination, vaccine-specific antibody levels increased significantly in both patients and controls (P &lt; 0.0001). A total of 80.5% of patients and 98.0% of controls achieved a ≥4-fold increase in antibody levels. Post-vaccination antibody levels were lower in patients than controls [ratio 0.44 (95% CI 0.31, 0.63)] and lower in patients receiving JAKi + methotrexate than JAKi monotherapy [ratio 0.43 (95% CI 0.24, 0.79)]. AEs, mostly mild/moderate, were common. One patient developed HZ and six patients (6.5%) had increased RA disease activity following vaccination. Conclusion: The HZ/su vaccine was serologically immunogenic in most RA patients treated with JAKi. Moreover, the vaccine had an acceptable safety profile. These results support recommendations for use of the HZ/su vaccine in this vulnerable population.</p>}},
  author       = {{Källmark, Hanna and Bergström, Tomas and Nagel, Johanna and Gullstrand, Birgitta and Einarsson, Jon T. and Bengtsson, Anders A. and Kapetanovic, Meliha C.}},
  issn         = {{1462-0324}},
  keywords     = {{herpes zoster; Janus kinase inhibitors; rheumatoid arthritis; vaccination; vaccine immunogenicity}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{2024--2033}},
  publisher    = {{Oxford University Press}},
  series       = {{Rheumatology (United Kingdom)}},
  title        = {{Serologic immunogenicity and safety of herpes zoster subunit vaccine in patients with rheumatoid arthritis receiving Janus kinase inhibitors}},
  url          = {{http://dx.doi.org/10.1093/rheumatology/kead552}},
  doi          = {{10.1093/rheumatology/kead552}},
  volume       = {{63}},
  year         = {{2024}},
}